Background to this inspection
Updated
10 January 2020
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
Inspection team
This inspection was carried out by two inspectors.
Service and service type
Nazareth House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
Notice of inspection
This inspection was unannounced.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used all this information to plan our inspection.
The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.
We used all this information to plan our inspection.
During the inspection
We spoke with six people who used the service and two relatives about their experience of the care provided. We spoke with seven members of staff including the registered manager, deputy manager, registered nurses, care workers and the chef.
We reviewed a range of records. This included six people’s care records and multiple medication records. We looked at two staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.
After the inspection
We continued to seek clarification from the provider to validate evidence found. We looked at training data and quality assurance records.
Updated
10 January 2020
About the service
Nazareth house is a care home supporting people who required residential and nursing care for up to 64 people over the age of 65. At this inspection, 30 people were living at the service.
People’s experience of using this service and what we found
At the last inspection in April 2019, we found that people were at risk of harm and the service was placed in special measures. At this inspection we found that whilst there had been some improvement, people remained at risk of harm because systems, processes and staff, failed to identify people’s needs and presenting risks and take timely action.
Staff did not always adequately handover to other staff, people’s needs. Missing important information about risks and actions to prevent and mitigate these.
Medicines were managed safely, although for those on covert medications (Given without the person’s consent or knowledge and hidden in food or drink) staff had not always followed best practice guidance. We made a recommendation about this.
Staffing had improved because the scale of the service had reduced to three floors of one wing of the building. This meant staff were more responsive.
External stakeholders had expressed continued concerns about meal time experience for people. We saw that the registered manager had made efforts to improve this and remained a work in progress.
People were not always supported to have maximum choice and control of their lives. However, staff supported them in the least restrictive way possible and in their best interests.
Staff had not received a values-based interview and opportunities were missed at the point of interview and within supervisions to identify additional training to ensure staff had the correct skills and values. We made a recommendation about this.
Although efforts had been made to ensure that all safety checks on potential staff had been carried out prior to employment there were missed opportunities at the recruitment stage to put in place training to meet potential staffs identified weaknesses. We made a recommendation about this
Staff were caring in how they supported people, but support was task orientated rather than person centred. People were not always asked how they would best like to live their lives.
Care plans had improved but continued to need improvement to ensure that they were person centred. We made a recommendation about this.
Oral hygiene care was sometimes poor for those who were not able to manage their needs without support. We made a recommendation about this.
People with access to communal areas had good opportunity for engagement and activity. But for those people cared for in their bedrooms this was poor. We made a recommendation about this.
People at the end of their life did not receive care in line with gold standards, which aims to ensure people are supported to plan ahead to live as well as possible right to the end of their lives.
The new registered manager had begun to make improvements at the service and had identified some of the concerns we found at this inspection.
People, relatives and staff were engaged with the service and the registered manager was visible. Staff told us they felt supported by managers.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection (and update)
The last rating for this service was inadequate (Published 5 June 2019).
Previous breaches
The provider completed an action plan after the last inspection to show what they would do and by when to improve.
At this inspection whilst some improvement had been made to the well led domain, enough improvement had not been made/ sustained in the safe domain and the provider was still in breach of regulations. The safe remains rated as Inadequate and therefore the service remains in special measures.
Why we inspected
This was a planned inspection based on the previous rating.
We have found evidence that the provider needs to make improvements. Please see all sections of this full report.
You can see what action we have asked the provider to take at the end of this full report.
Follow up
We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
Special Measures:
The overall rating for this service is ‘Requires improvement’. However, the service remains in 'special measures'. We do this when services have been rated as 'Inadequate' in any Key Question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services in special measures. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.
If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.
For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.